DR. HOOK- Tech support: Labs provide crucial info

Don't you love dogs? If dogs had a thumb, I wonder if they would create a peaceful society. Lassie was a loving Collie. Rin Tin Tin was a beautiful German Shepard (not a killer like Cujo, the rabid St. Bernard). Benji was an amazing mixed breed. Snoopy was an imaginative beagle, but never really looked like a beagle to me. Goofy & Pluto-– well, what are they— Labs?

My best friends have a new lab in their house, Zoro. He is– well, was– a little black Lab that used to fit in the palm of my hand. In just a brief six months, he has become a 50-pound Lab with big feet, a very wet mouth, and a tail that can knock over all the drinks on a coffee table.

In medicine, labs are not cute, loving dogs. If you have ever seen a doctor, you have more than likely had some tests done that required the specialty of a lab, as in laboratory. For example, in general you can't tell someone's cholesterol level or sugar by just looking at him. So you need to get some labs done!

I communicate with all my patients about their lab results. It takes me forever, but it's worth doing. The majority of my patients are okay with my interpretation and summary of their results. I don't give them every single-dingle number and result, because usually it only confuses them. However, I do have some patients who want to have a copy of the labs, and then I wait for the dreaded questions: "Hey, what does this mean? And that? And this? And that? and...."

Yes, some lab results are highlighted to be "out of normal range," but what these patients don't realize is the context of the results. Not everything out of normal range is bad, and not everything within normal range is good. So I hate it when a patients yells, "Hey, Mr. Man! You didn't tell me about this!" Ah, that was because it's not big deal. So take the hand off the hip and put the finger down. You aren't Tyra Banks.

Also, who does quality control on this "normal" range? For the most part, the laboratory technologists determine it. My ice-dancing partner is a lab tech at Martha Jefferson Hospital, and she works really hard to make sure all the results are correct. If their laboratory instruments are off by just a little, all hell breaks loose. Could you imagine receiving labs that are consistent with kidney failure, heart attack, lupus, or diabetes?

Also, deciding what the normal range should be is a challenge. If you make the normal range too small, then you might miss a bunch of people who have something wrong. If you make the range too big, then you might misdiagnose a bunch of healthy people. (If it's not one thing, it's another.)

False positives are never fun. False HIV+, false lupus+, false syphilis+, etc. all can occur. Sometimes, one condition can make something in the labs light up elsewhere– like a cross reactivity. This is when you wish you had a False ID."Blood? You never took my blood..."

In the Emergency Department, fast lab results are essential– so the labs are opened 24-7. My skating partner, Sue, works night shifts to make sure every patient is covered. Sputum gram stains and cultures, lumbar puncture panels, cardiac enzymes are all par for the course at any time. Why don't they show this on ER? Maybe they should make a show, LAB? The two lead characters fall in love over the microscope while two supporting characters split up by the centrifuge. There's an idea!

For more information on an exciting career as a lab tech, call Nancy Lewis 434-982-7170 at Martha Jefferson Hospital.